Most people experience back problems from time to time and experience pain in the lower back, neck or mid-back. In fact, back pain is the most common physical complaint in the adult population and the leading cause of temporary disability. Back pain can be mild or severe, short-term pain, or chronic.
Back pain includes: muscle and tendon pain, herniated disc pain, fracture or other back problems. Most often, the reasons have a long history. Most often, back pain is caused by diseases of the spine.
The structure of the spine is designed for extreme loads. The structure of the spine is stable enough for a person to walk (stand) and flexible enough to perform trunk movements.
A healthy spine is S-shaped when viewed from the side and has natural curves in the lumbar, thoracic and cervical spine. The spine is the main supporting bearing part of the torso. In addition, the spine protects the spinal cord and spinal cord roots with its bone structure, thus ensuring the normal innervation of organs and tissues.
Between each of the 24 vertebrae there are intervertebral discs that perform a cushioning function.
Reasons
Back pain refers to problems that a person mostly creates for themselves. Back problems and back pain are most often caused by bad habits that have accumulated over a long period of time. These bad habits include:
- Poor posture
- Overvoltage during work
- Incorrect posture at the desk or driving
- Repeated stretching or extension of the spine or abnormal sharp lifting of weights.
The results of habits rarely appear immediately, but more often their negative effects accumulate over time. One of the most common types of back pain is pain associated with tension in the muscles surrounding the spine. Most often, back pain associated with tension, muscles occur in the lumbar spine and in the cervical spine. If muscle tension is associated with lifting heavy objects, then the pain can be excruciating.
Sometimes back pain occurs for no apparent reason. In such cases, they talk about non-specific back pain. Such pain can develop due to weakened muscles that cannot cope with everyday stress, such as walking, bending, and extending. In addition, such nonspecific pain can be triggered by poor sleep, general fatigue or exposure to stressful situations.
Chronic pain in myofascial pain syndrome is caused by localized muscle tension. Sometimes this localized muscle tension is due to stress or other emotional issues.
Pregnancyis often the cause of the disease and this is associated with both hormonal changes in the woman's body and weight gain and excessive stress on the spine and legs.
Injuries in contact sports, accidents and falls can also cause back problems, ranging from minor muscle strain to serious injuries to the spine and spinal cord.
It is important to understand that back pain is one of the symptoms of the disease and is not a diagnosis. Medical conditions that can cause back pain include the following:
Mechanical Problems: Mechanical problems are related to the movements of the spine or the sensations a person experiences when performing certain movements. The most common mechanical cause is degeneration of the intervertebral discs (osteochondrosis), when involutional changes occur in the intervertebral discs and deterioration of the amortization functions of the discs, which leads to the appearance of pain. Another cause of back pain is degenerative changes in the joints of the spine (spondyloarthrosis). Other mechanical causes include muscle spasms, muscle tension, and herniated discs.
Injuries: Spinal injuries such as sprains and fractures can cause both acute pain and chronic pain. Sprains, tears in the ligaments that support the spinal column, can arise from torso twisting or improper lifting. Fractures of the vertebrae are often the result of osteoporosis, a disorder in which bone density is impaired. Less commonly, back pain can be caused by more severe injuries that result from crashes and falls.
Acquired conditions and diseases. Many medical conditions can cause or contribute to pain. These include scoliosis, kyphosis, kyphoscoliosis, in which there is usually no pain until midlife. Various types of arthritis (osteoarthritis, rheumatoid arthritis, ankylosing spondylitis), stenosis of the spinal canal, which affects the nerve roots of the spinal cord. Diseases such as osteoporosis are painless in themselves, but can lead to vertebral fractures, which will manifest itself as severe pain. Other causes of back pain include pregnancy, kidney infections or urolithiasis, endometriosis, fibromyalgia, which is characterized by chronic fatigue and diffuse muscle pain.
Infections and tumors. Although infections are not common causes of illness, infections can nevertheless cause pain. If the bone tissue is affected, then we are talking about osteomyelitis, if the infection affects the intervertebral discs, then we are talking about discitis. Tumors are also relatively rare in pain. Sometimes tumors of the spine are primary, but most often the tumors are metastatic and the primary focus is located in another part of the body.
While the causes of back pain are usually physical, it is important to understand that emotional stress can play a role in both the intensity of the pain and the duration. In addition, stress and emotional well-being can affect skeletal muscle tone. So in the presence of depression and anxiety, back pain may be more intense. In addition, insomnia or lack of sleep can also contribute to or worsening pain.
Back pain is only a symptom and may be reflected. Many diseases of the peritoneum and pelvic organs can cause spinal pain (appendicitis, aneurysm, kidney disease, bladder disease, infections, and pelvic inflammatory disease).
Risk Factors
- Age over 40
- Male gender
- Family history
- Previous injuries
- Pregnancy
- Surgical interventions on the spine in the past
- Congenital malformations of the spine.
- Lack of regular exercise
- Work or activity that requires prolonged sitting of lifting weights.
- Smoking. People who smoke more often than people who do not smoke experience back pain.
- Overweight. Being overweight, especially those with fat around the waist, can put more strain on the back and tend to have weak muscles and limited mobility
- Poor posture. Impaired posture leads to a disturbance in the distribution of load vectors and to muscle tension, muscle spasm and pain.
- Stress. Stress and other emotional factors are believed to play an important role in back pain, especially chronic pain. Many people unknowingly tense their back muscles when they are under stress.
- Condition after a long period of depression.
- Long-term use of drugs (such as steroids) that weaken bone tissue.
- Lung diseases that lead to chronic cough.
Symptoms
Most people have experienced back pain during their lives. There are many reasons for back pain, some of them are created by a person himself. Other causes include accidents, muscle sprains, sports injuries, and various illnesses. Although the causes can be different, most often they are marked with the same symptoms.
- Persistent pain or stiffness in any part of the spine, from the base of the neck to the coccyx
- Acute, localized pain in the neck, upper back or lower back — especially after lifting heavy objects or performing strenuous activities. (Pain at the top can also be a sign of a heart attack or other life-threatening conditions. )
- Chronic pain in the middle or lower part, especially after prolonged sitting or standing.
- Pain in the lower back radiating to the buttocks of the leg.
- Inability to stand up straight.
But there are symptoms that warrant seeking medical attention
- Feeling of numbness, tingling, or weakness in the arms or legs, as this may indicate spinal cord injury.
- Lower back pain radiates to the leg, which may be evidence of root compression (radiculitis).
- The pain increases when coughing or leaning forward, which may be a sign of a herniated disc.
- The pain is accompanied by a fever, burning sensation when urinating, which may be a sign of a urinary tract infection.
- Disorders of bowel or bladder function
- History of cancer
- Weight Loss
- Long-term steroid use
- History of trauma
- Increased malaise even after rest.
- Pain that lasts more than a month
- Night Pain
- No effect of treatment
- History of drug use
Diagnostics
Due to the fact that the cause of back pain can be various conditions, then, first of all, the doctor's careful collection of anamnesis and symptoms is important. Both the localization of pain and the intensity, the presence of irradiation are important. The physical examination includes a careful examination of the neurological status (reflex activity, muscle strength, sensitivity, etc. ). If you suspect a disease of the pelvic organs, the doctor may prescribe a consultation with a gynecologist, urologist.
Instrumental research methods
Radiography is usually of little value in diagnosing spinal pain, especially if there are no severe symptoms. The use of radiography is indicated for acute significant injuries or minor injuries in patients over 50 years old, patients with osteoporosis, or a history of long-term steroid use.
MRI is the most informative diagnostic method and allows high-quality visualization of both bone and soft tissues and allows diagnosing both degenerative changes and tumors or infections.
For clearer visualization of bone changes, CT may be recommended.
EMG and ENMG allows to determine the conduction along nerve fibers and muscles and, as a rule, is used in the diagnosis of chronic back pain.
Ultrasound examination of the abdominal organs or organs of the small pelvis, kidneys is necessary in the case when it is necessary to differentiate the source of pain.
Laboratory research methods are also used for differential diagnosis of inflammatory diseases or infections.
Treatment
There is no universal treatment for back pain. Treatment of back pain in each individual case depends on both the genesis of pain manifestations and the individual characteristics of a person, since people's perception varies significantly.
Medical treatment includes the use of various drugs, both conventional analgesics or NSAIDs, as well as muscle relaxants or antibiotics for infections. With chronic pain syndrome, it is possible to use antidepressants, tranquilizers or neuroleptics.
Non-drug treatments such as physiotherapy, massage, manual therapy, acupuncture and exercise therapy have been widely used in the treatment of back pain. These methods of treatment are effective for both acute and chronic pain manifestations associated with diseases of the spine.